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HomeMy WebLinkAboutBLD2000-00376 PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360) 379-4450 FAX (360) 379-4451 (800)831-2678 PERMIT #: BLD00-00376 Received Date 6/12/2001 SITE ADDRESS: 77 BEACH DR Issue Date 6/12/2000 QUILCENE, 98376 Expiration Date 6/12/2001 APPLICANT: WILLARD NELSON PHONE: (360)765-5092 77 BEACH DR QUILCENE WA 98376 T 15 SUBDIVISION: Block: Lot: PARCEL NUMBER: 701344021 Section: 34 Township: 27N Range: 01W CONTRACTOR: R & S SALES AND SERVICE PHONE: (360)732-4585 PO BOX 708 CHIMACUM WA 98325 Contractor's License RSSALS*022PB Expires 10/01/2000 OWNER, if different: PROJECT DESCRIPTION PROPANE TANK& FREE STANDING STOVE INSTALLATION THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 06/12/2001. REQUIRED INSPECTIONS: [- 1 Tank/Line/Appliance: ,,k-7/ [ '} FinalApproval: Cie. (f.G 7 d© BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. Inspector's Phone Hours 8:00 a.m. - 9:00 a.m. SPECIAL CONDITIONS MAY APPLY - SEE REVERSE HOT LINE AVAILABLE 24 HOURS A DAY BUILDING PERMIT APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00376 Received Date: 6/12/2001 SITE ADDRESS: 77 BEACH DR QUILCENE, 98376 APPLICANT: WILLARD NELSON PHONE: (360)765-5092 77 BEACH DR QUILCENE WA 98376 SUBDIVISION: Block: Lot: T 15 PARCEL NUMBER: 701344021 Section: 34 Township: 27 N Range: 01 W CONTRACTOR: R & S SALES AND SERVICE PHONE: (360)732-4585 PO BOX 708 CHIMACUM WA 98325 Contractor's License RSSALS*022PB Expires 10/01/2000 ARCHITECT/ ENGINEER : PROJECT DESCRIPTION: PROPANE TANK & FREE STANDING STOVE INSTALLATION TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 1997 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM. PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: Prop: Seismic Streams Total: Total: Flood Way Flood Plane F&W Landslide Routing Date: Shoreline Aquifer , Forest: Commercial Rural —1-'r xlmlty - I-'Iat U dltions Type Amount Paid By: Date: Receipt: Approved/pate Propane Tanks/Stoves $48.00 MAM 06/12/01 31673 Total: $48.00 I:\F_BLD_App_Bld.rpt 10/29/99 JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450 INSTALLATION PERMIT APPLICATION WOODSTOVE X PROPANE TANK PELLET STOVE OTHER ri✓-P t' S/'Y+-fri � - �v4 tf N SITEADDRESS:977 ,d / l 11#/ROAD NAME c /z_ C,,e/ - 0.4...,/L C-NC`e , ZIP 7c - 5-4'% 9 DIGIT PARCEL ID NUMBER 76/ 3'// d 472 Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT /` /S. ..5, PS f .e.'V i C 'e PHONE r?C)/ "//Z Z MAILING ADDRESS 10 = /J 70 Clih*a C(. Itit IAA ZIP ? ,,,?a.S~ PROPERTY OWNER !/5/yi 71 ,4ykrr Alc,v, PHONE 7 -rO9Z MAILING ADDRESS c ---- _ _ _.,, „ Q --12 4- al�fr4-7C,C W/4- ; ZIP /(rJ/74o CONTRACTOR '1 f ,S�t-� , _,erV 1 C r PHONE ,per—/I2 2 MAILING ADDRESS / , GCS O)C ,©r ft iif-ra c a J . . WA ZIP f'e5"3.2 STATE LICENSE# CC /¢P23 0 iQ S5' /S 4" ,22Pa EXP. DATE j0�0/,modOO FEDERAL I.D. # 6O/ 9d 3` $OS/ ea/ Deo / By signing the application form,the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this application packet may result in this permit being null and void. I further agree to save, indemnify and hold harmless Jefferson County against all liabilities,judgments, court costs, reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. 1 further agree to provide access and right of entry to Jefferson County and it's employees, representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to the applicant's property or structure shall be requested and shall occur during regular business hours. APPLICANT SIGNATURE ,�,- „ e. DATE 4 / /2 / v'0 FOR OFFICE USE ONLY BASE FEE yr 00 RECEIPT# ` , � . CAS CK TOTAL DATE ,/J�f oo H:\HOME\PLNCNTR\FORMS\I N STALL.DOC 10/99